Transcript
Making Hospitals WorkHow to improve patient care while savingHow to improve patient care while savingeveryone’s time and hospitals’ resources
With I T l d M B kWith Ian Taylor and Marc BakerSenior Faculty Members of the UK’s Lean Enterprise Academy and authors ofMaking Hospitals WorkMaking Hospitals Work
Lean in Healthcare WorkshopsPhiladelphiaPhiladelphia
• Key Concepts of Lean in HealthcareSeptember 29 30September 29-30
• Making Hospitals WorkSeptember 30-31September 30 31
• Value-Stream Mapping for HealthcareOctober 1
• More information: lean.org, click Educationg,
Introductory CommentsIntroductory Comments
Mark Graban
Author:Lean Hospitals:
I i Q lit P ti t S f tSenior Fellow, LEI
Improving Quality, Patient Safety, and Employee Satisfaction
Why Lean in Healthcare? (U.S.)
Universal ProblemsUniversal ProblemsWaste Errors
C SilosCost
WaitingWork-Arounds Waiting
Staff FrustrationStaff Frustration
Lean Works in HealthcareLean Works in Healthcare
•Purpose Patients
•Process•People•People
Benefits f Lof LeanStaff &
ProvidersHealthcareOrganizationg
Results from LeanResults from Lean•Safety
• Zero central line infections for patients
•QualityZero medication reconciliation errors• Zero medication reconciliation errors
•Time• “Door to Balloon” time in 37 minutes (national goal = 90)Door to Balloon time in 37 minutes (national goal 90)
•Cost• 12% productivity improvement in 3 years
•Morale• Better employee satisfaction scores, lower turnover
Healthcare Value LeadersHealthcare Value Leaders
www healthcarevalueleaders orgwww.healthcarevalueleaders.org
Our Initial NetworkOur Initial Network
Group Health Cooperative - Seattle, WA
Gundersen Lutheran Health System - La Crosse, WI
Harvard Vanguard Medical Associates - Boston, MA
Hotel Dieu-Grace Hospital - Windsor, Ontario,
Iowa Health System - Des Moines, IAyJohns Hopkins Medicine - Baltimore, MD
Lawrence & Memorial Hospital - New London, CT
Lehigh Valley Health Network, Allentown, PA
McLeod Health - Florence SCMcLeod Health Florence, SC
Mercy Medical Center - Cedar Rapids, IA
Park Nicollet Health Services - Minneapolis, MN
St. Boniface General Hospital - Winnipeg, Manitoba,
St Joseph Health System Orange CASt. Joseph Health System - Orange, CA
ThedaCare - Appleton, WI
UCLA Health System - Los Angeles, CA
University of Michigan Health System - Ann Arbor, MI
Making Hospitals Work
•Marc BakerMarc Baker
•Ian TaylorIan Taylor
Grasping the Situation:Wh t i P bl ?What is our Problem?
The sort of changes we are predicting
Working out what the real problem is
How Big is gthe BIG
P bl ?Problem?What does this Medical
Demand Look Like?
• Who are they?• How many of them are there?• How similar or different are they?• Where do they come from?• Where do they come from?• What happens to them?• Where do they go?
Seeing where different types of patients & demand rates
Capturing where the patient comes from & where they are discharged to. The spine – Where the patient physically
i t h th i it d l & ifexperiences a step where they experience a wait or delay & if they are pushed or pulled.
Adding the data boxes & the time line capturing the time taken experiencing steps & the time p g p
experiencing waits or delays (totalling both)
A completedA completedData Box
Capturing the information flow – notes & electronic data or transactions & their
connections with the spine
Capturing the scheduling and managementprocesses & their connections with the spine
Don’t worry if yours ends up looking like this !!!!
Deep Causes of the Current
1. No plans for patients (therefore status checks impossible).1. No plans for patients (therefore status checks impossible).2. Departmental working hours are not synchronised3. Capacity (staff) are not calculated to meet demand4. The frequency of interventions are not designed to meet
d ddemand
Staff/Departmental Availability
Nursing Availability to Discharge from Wards
1. What is/are takt times?
2. Where can we remove th t i l ( iti )?the triangles (waiting)?
3. What can we do where we cannot remove the triangles?
4. Which process should k i lwe make our single
point of schedule?
Demand: What are your takt times?“Takt” = rate of patient/customer demand for services
Demand to Get OutDemand to Access
Where can we take out the triangles (waiting)?
ED Cell Layout
A fishbone icon identifying the key support service in treating a patient on a wardin treating a patient on a ward
Zooming into the Fishbone
What can we do where we can’t remove triangles?
Need Bed Signal Supply Bed Signal
B d Bed
Customer Process
Supplier Process
Buffer containing a constant number of
Bed Bed
Process Processconstant number of empty beds
Reversing the Polarity (You cannot ‘pull’ the customer) In Healthcare (asReversing the Polarity (You cannot pull the customer) – In Healthcare (as in some other service industries) the Patient is actually present in Door to Door system & is therefore both the Customer & the Product, moving from left to right. Unique to an Emergency Care environment is the fact that you cannot prevent the Customer should they need to from entering the systemcannot prevent the Customer, should they need to, from entering the system
Fact - Local Scheduling Creates Triangles
Schedule Schedule ScheduleSc edu e Sc edu e
At which single point will you schedule?....The Pacemaker
The schedule is sent to a single point in the entire process which works to that schedule, with all other parts of the process subordinate to it.
If the pacemaker is told to ‘speed up,’every other bit of the process speeds up, to keep pace.
If the pacemaker is told to ‘slow down,’ every other part of theprocess slows down in response.
The Visual Hospital in Action – with the Master Patient SchedulerMaster Patient Scheduler
4: Where is the single point of schedule (pacemaker)?
What Happens at the Pacemakerpp
Flow, Pull & Pacemaker
• Beat, Takt(s) • Balanced( )
• Synchronized
• Flow, Flow, Flow
• Standardized
• Flexible
Synchronized Standardized
Designing the Future State
The Future State: With the Questions Answered
Pacemaker
Flow
Buffers
Achieving the Future State: Creating an Action Plan
Who’s going to make sure all this happens ????
The Value Stream Manager:• Preparing the Business Case• Implementation of the Transition Plan• Cuts across all Departments & Divisions (silos) - who all have different targets and
g
Cuts across all Departments & Divisions (silos) - who all have different targets and objectives
And when it’s in place:• Responsible for all Medical Patients - the ‘Patient Representative’• Ensures that Medical patient’s needs are met ‘On Time & In Full’ • Responsible for resolving any issues that prevent this – At the very highest level ifResponsible for resolving any issues that prevent this At the very highest level if required
Who ‘currently’ has the time to do all this ????y
Healthcare ResourcesBooks & DVDs
Workshops
• Key Concepts of
Website
A ti l t di id• Key Concepts of Lean in Healthcare
• Value-Stream
Articles, case studies, videos, forums, templates, and more at: • lean.org
Mapping for Healthcare
Making Hospitals
• leanuk.org• healthcarevalueleaders.org
C ti C t• Making Hospitals Work
Connection Center@lean.orgFind and communicate with other lean thinkers in healthcare
Questions & AnswersQuestions & Answers
Marc BakerIan Taylor
Selected questions not answered in the webinar are posted on the webinar archive page
Next Steps:Next Steps:• Share the webinar link
• Read Lean Hospitals and Making Hospitals Work
• Lean-in-Healthcare Workshops, PhiladelphiaSept. 29 to Oct.1:
•Value-Stream Mapping for Healthcare.pp g•Key Concepts of Lean in Healthcare•Making Hospitals Work
More info: lean.org
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